One-to-many source to concept mappings - creating two records in OMOP for one record in the source?

Correct approach to do what? What is the use case?

Hepatitis can cause an hepatic coma, but that is not a patient-specific fact. It is generic, and should therefore be part of the reference (Vocabularies) tables, rather than in FACT_RELATIONSHIP. ICD-9-CM has that as a pre-coordinated concept composed of two distinct conditions (one a disease of the liver, the other of the brain). For whatever reason they decided to have such a pre-coordination here, but they certainly don’t have all possible conditions that could be linked because one causes the other.

But again: What are you trying to achieve?